Role of central nervous beta-adrenoceptors in the prevention of ventricular fibrillation through augmentation of cardiac vagal tone

Åblad, Bengt; Bjurö, T; Björkman, Jan-Arne; Edström, Therese; Olsson, Gunnar

doi:10.1016/0735-1097(91)91625-o

Cited by 64 publications

(20 citation statements)

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“…ß-Blockers do not only decrease sympathetic influence on the heart, but they also increase vagal tone [11][12][13]. A differential effect of different ß-blockers, suggesting better preservation of vagal tone during stress by lipophilic ß-blockers such as metoprolol, has been reported from animal experiments [33].…”

Section: Discussionmentioning

confidence: 93%

Effects on Heart Rate Variability of Isosorbide-5-Mononitrate and Metoprolol in Patients with Recent Onset of Angina pectoris

Wennerblom

Lurje²,

Westberg³

et al. 1998

Cardiology

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Background: β-Blockers reduce sympathetic tone, increase vagal tone and improve prognosis in ischaemic heart disease. Nitroglycerin, being a vasodilator, may theoretically have an opposite effect and worsen the prognosis. The purpose of the present study was to analyse heart rate variability (HRV), which reflects autonomic tone, in angina patients on isosorbide-5-mononitrate (IS-5-MN) and/or metoprolol. Methods and Results: Thirty-two patients (32–81 years old), with recently developed angina (median duration: 3 months), showing no other disease and on no drugs, were Holter-monitored 24–48 h at baseline and after 4–5 days on IS-5-MN (mean daily dose: 33 mg), on metoprolol (mean daily dose: 184 mg) and on the combined treatment. Recordings were analysed on the Marquette Series 8000 Holter scanner. Both IS-5-MN and metoprolol significantly reduced myocardial ischaemia (ST integral) and ventricular tachycardias. Metoprolol induced significant changes in the following parameters (baseline versus metoprolol): high-frequency peak 9 ± 4 versus 11 ± 4 ms (p < 0.001), low-to-high frequency ratio 2.5 ± 0.6 versus 1.9 ± 0.6 (p < 0.0001), root mean square of RR interval difference 23 ± 7 versus 31 ± 9 ms (p < 0.0001), RR intervals differing more than 50 ms from the preceding one 4.8 ± 3.9 versus 10.0 ± 7.0% (p < 0.0001), mean of all 5-min standard deviations 50 ± 12 versus 56 ± 11 ms (p < 0.001) and mean RR interval 819 ± 90 versus 1,019 ± 120 ms (p < 0.00001). The combined treatment caused approximately the same HRV changes as metoprolol alone. IS-5-MN had no significant effect on any HRV parameter, neither alone nor in combination with metoprolol. Conclusion: A clinically effective dose of metoprolol had potentially positive effects on HRV with increase in vagal and decrease in sympathetic tone while IS-5-MN had no effect on HRV, neither positive nor negative, neither alone nor in combination with metoprolol.

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Section: Discussionmentioning

confidence: 93%

Effects on Heart Rate Variability of Isosorbide-5-Mononitrate and Metoprolol in Patients with Recent Onset of Angina pectoris

Wennerblom

Lurje²,

Westberg³

et al. 1998

Cardiology

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“…Thus, an increase in vagal tone appears to be protective. Several studies in infarct survivors support this premise [15][16][17].…”

Section: Mechanisms Of Sudden Cardiac Deathmentioning

confidence: 85%

Beta-blockers and amiodarone for the primary prevention of sudden cardiac death

Frankenberger

Steinber

1999

Curr Cardiol Rep

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Sudden cardiac death remains a major public health care problem, generally occurring in patients with ventricular dysfunction. Beta-blockers, already of proven benefit for patients after myocardial infarction, have recently been shown to improve functional status and mortality outcomes in patients with heart failure. Amiodarone, a potent antiarrhythmic drug, was recently studied in a number of randomized clinical trials involving patients with heart failure and patients after myocardial infarction. Routine use of amiodarone cannot be recommended in these patient groups, but serious adverse outcomes were not observed. When antiarrhythmic drug therapy is required, amiodarone is the drug of choice for patients with structural heart disease.

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“…In a separate study, coronary artery occlusion in anesthetized rabbits resulted in VF in 92% of animals. After treatment with atenolol for 3 weeks, a similar number of animals (83%) died, compared with marked reduction in VF mortality after three weeks of treatment with metoprolol [62]. The degree of ischemia and sympathetic activation was comparable with the two β-blockers.…”

Section: Antifibrillatory Actions Of β β β β-Adrenergic Receptor Blocmentioning

confidence: 86%

β-Adrenergic blocking drugs as antifibrillatory agents

Reiter

2002

Curr Cardiol Rep

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Beta-Adrenergic blockade is associated with a significant reduction in mortality in most patients with structural heart disease. Clinical trial data involving patients after myocardial infarction or with congestive heart failure demonstrate that a reduction in sudden death accounts for much of the observed mortality reduction. Beta-adrenergic blockade inhibits the proarrhythmic effects of both neural and humoral sympathetic stimulation and inhibits the vagal withdrawal that accompanies ischemia. Although it does not have a dramatic effect on spontaneous ectopy or inducible monomorphic ventricular tachycardia, experimental and clinical data suggest that it inhibits the development of ventricular fibrillation by several mechanisms.

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Role of central nervous beta-adrenoceptors in the prevention of ventricular fibrillation through augmentation of cardiac vagal tone

Cited by 64 publications

References 0 publications

Effects on Heart Rate Variability of Isosorbide-5-Mononitrate and Metoprolol in Patients with Recent Onset of Angina pectoris

Effects on Heart Rate Variability of Isosorbide-5-Mononitrate and Metoprolol in Patients with Recent Onset of Angina pectoris

Beta-blockers and amiodarone for the primary prevention of sudden cardiac death

β-Adrenergic blocking drugs as antifibrillatory agents

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